Alcohol Withdrawal: Timeline, Side Effects, Detox

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Alcohol is the most common substance of abuse in the United States. According to the 2019 National Survey on Drug Use and Health, more than 85% of people have tried alcohol at least once. More concerning, more than 25% of adults said they engaged in binge drinking in the month before the survey. Over 14 million people had an alcohol use disorder in 2019. In order to address an alcohol use problem, you may have to go through alcohol withdrawal. Alcohol can cause some extremely uncomfortable and even dangerous withdrawal symptoms. 

What are these symptoms, and how can they be treated?

Will You Experience Alcohol Withdrawal Syndrome?

Alcohol withdrawal syndrome can be potentially dangerous if you go through it on your own. But how do you know if you’re going to experience alcohol withdrawal? Alcohol withdrawal can be diagnosed with the help of a doctor, but there are a few risk factors you can be aware of to avoid going into withdrawal alone. Alcohol withdrawal is caused when you stop drinking alcohol after developing a chemical dependence on it. Chemical dependency refers to a rebalancing of your brain chemistry around the consistent presence of alcohol. Alcohol is a depressant, so your brain may stop producing its own depressing chemicals. It may try to counteract the depressant effects of alcohol with its own excitatory chemicals. When you stop drinking, your brain chemistry will be unbalanced, and you’ll experience uncomfortable withdrawal symptoms.

But how do you know if you’ve become chemically dependent?

Chemical dependence occurs after a period of consistent heavy drinking. The exact amount of alcohol it takes to make you dependent may vary from person to person. But several weeks to several months of consistent binge drinking can lead to dependence. For many people, severe alcohol use disorders are caused by years of alcohol misuse. Chronic heavy alcohol use is one of the most significant risk factors for alcohol withdrawal syndrome. You may be at risk for more severe alcohol withdrawal symptoms if you have a history of seizures. Signs and symptoms of alcohol withdrawal include:

  • Insomnia
  • Agitation
  • Anxiety
  • Excessive sweating
  • Hallucinations
  • Tremors
  • Restlessness 

If you experience these symptoms when you try to cut back or stop drinking, you may experience alcohol withdrawal syndrome before you reach sobriety.

withdrawal-from-alcohol

What are the Symptoms of Alcohol Withdrawal?

Alcohol withdrawal is caused when your body and brain are recovering from alcohol dependence. Your brain has adapted to a steady stream of the depressant, and when it stops, your nervous system may become overactive. This can cause symptoms like anxiety, insomnia, shaky hands, insomnia, sleep disturbances, restlessness, racing thoughts, nausea, high body temperature, increased heart rate, and heart palpitations. The severity of your symptoms will depend on several factors. How long were you chemically dependent on alcohol? How much did you drink on a regular basis? If you were used to binge drinking every day for several years, your withdrawal symptoms are more likely to be intense. If you binge drank every other night for a few months, your withdrawal experience might not be as severe. 

Another major factor is how you stop using. If you’re used to heavy drinking, and you quit cold turkey, you’re likely to experience more severe withdrawal symptoms. If you taper off drinking by cutting back slowly, or if you participate in a detox program that prescribes another depressant like a benzodiazepine to taper, you may avoid some of the most severe symptoms. 

When Will Symptoms Show Up?

The timeline on which you experience withdrawal symptoms can vary based on your history of drinking. Heavy drinking for a long time can result in feeling withdrawal symptoms sooner after you stop drinking. Many of the pleasant effects of alcohol start to wear off as soon as your blood alcohol level starts to fall. But your first withdrawal symptoms may arrive within five to ten hours of your last drink. This may include anxiety, restlessness, and tremors. As symptoms progress, you may feel nauseous, and sleeping may prove difficult. 

Between 12 and 24 hours, your symptoms will worsen, and you might start to experience hallucinations. You may also feel the sensation of something crawling on your skin like a tingling. Between 24 and 48 hours, your symptoms may peak. That means they’ll be at their most intense before starting to fade. Before that, you may be at risk for a seizure or other severe symptoms. 

Between three and seven days, some symptoms may start to get better, but you’re still in the window where you could experience a seizure or a condition called delirium tremens.

How Long Does Withdrawal Last?

Alcohol withdrawal symptoms can start to improve after five days. While you may still experience discomforts like anxiety and insomnia, the most severe symptoms will start to go away. Psychological symptoms may linger if they aren’t addressed. Anxiety problems can persist for weeks or months. However, addressing these issues in treatment can help to alleviate them.

Is Alcohol Withdrawal Dangerous?

Alcohol, like other central nervous system depressants, can be potentially life-threatening during withdrawal. Alcohol withdrawal can cause seizures that can lead to injury and accidents. Tonic-clonic seizures can happen suddenly, causing you to fall down and thrash your body. If you’re up, walking, or driving, this can lead to severe injury. 

Alcohol withdrawal can also lead to a condition called delirium tremens, which is characterized by the sudden onset of severe confusion, heart palpitations, chest pains, seizures, high blood pressure, sweating, and dehydration. Without treatment, delirium tremens can kill one out of 20 people that experience it. With treatment, your risk of experiencing life-threatening symptoms is diminished. 

Though alcohol withdrawal can be dangerous, the risk of severe symptoms is much lower with treatment. Plus, active alcoholism is also dangerous. An unaddressed alcohol use disorder can lead to serious health conditions, alcohol intoxication, and other consequences. Alcohol use problems can affect your relationships, financial stability, career, and nearly every aspect of your life. Addiction is progressive. Even if you feel that your alcohol use issue is under control now, it will likely get worse if you don’t address it. Alcohol treatment can help you get through the potentially dangerous stage of withdrawal safely and avoid or address some of the more severe consequences of addiction.

How is Alcohol Withdrawal Syndrome Treated?

Alcohol withdrawal is treated with medical detox, which is medically managed inpatient treatment. This is the highest level of care in addiction treatment. It will involve 24-hour care from medical professionals and clinicians with the goal of keeping you safe through withdrawal. When you enter detox for alcohol dependence, you may be given mediation that can help taper you off alcohol slowly to avoid severe symptoms. Benzodiazepines are another central nervous system depressant that might be used for this. 

Symptoms like insomnia and nausea may also be treated medically. While safety is the first priority of detox, medical professionals will help to keep you as comfortable as possible. Many detox centers also have clinicians on staff to help you deal with some of the deeper issues that might come with an alcohol use disorder. Addiction is associated with problems like anxiety, depression, and other mental health disorders. Mental health, drug cravings, and triggers may be addressed in detox, but they will continue to be treated in the next levels of care in addiction treatment.

What Happens After Alcohol Detox?

After you complete a detox program, the next step in treatment will depend on your specific needs. Addiction is a chronic disease that affects the reward center of the brain, and it usually requires more than a week of medical detox to address it effectively. When you enter an addiction treatment program, you go through an assessment process that’s intended to determine your specific needs. 

Doctors and clinicians often use the ASAM criteria to help place you in the level of care that can best help you. The criteria is a list of factors addiction treatment professionals can use to evaluate your needs. Factors include your withdrawal potential, medical conditions, psychological conditions, relapse potential, living environment, and readiness to change. 

If you’ve gone through alcohol detox already, your withdrawal potential should be low, but you may still have some medical needs that need to be monitored. If so, you may go through an inpatient treatment program that involves 24-hour medically monitored treatment. If you have high-level needs but don’t require round-the-clock medical services, you may go through an outpatient program that involves more than nine hours of treatment each week. 

Partial hospitalization programs involve more than 20 hours of treatment each week. As you progress and require lower levels of care, you may go through an outpatient program that entails fewer than nine hours of treatment per week. Through each level of care, you’ll go through therapy options that are tailored for you with the goal of leading to long-lasting sobriety.

Sources

American Psychiatric Association. (2017, January). What Is Addiction? from https://www.psychiatry.org/patients-families/addiction/what-is-addiction

ASAM. (n.d.). What is the ASAM Criteria? from https://www.asam.org/resources/the-asam-criteria/about

NIAAA. (n.d.). Alcohol facts and statistics. from https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics

National Library of Medicine. (2007). Alcohol withdrawal syndrome: How to predict, prevent, diagnose and treat it. from https://pubmed.ncbi.nlm.nih.gov/17323538/

Khan, G. (2020, December 12). Alcohol withdrawal symptoms: What you need to know. from https://www.webmd.com/connect-to-care/addiction-treatment-recovery/alcohol/alcohol-withdrawal-symptoms-timeline

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